How should we bill Medicare for cochlear devices replaced without cost to the hospital or beneficiary?
In November 2016, the Department of Health & Human Services Office of Inspector General (OIG) released a report related to the fact that hospitals did not always comply with Medicare requirements for reporting cochlear devices replaced without cost. (For this report, go to https://oig.hhs.gov/oas/reports/region1/11500508.asp.) Specifically, hospitals did not report the appropriate modifiers and charges or a combination of the appropriate value code and condition codes.
The OIG report gave the following guidelines for outpatient hospitals:
- For services furnished on or after January 1, 2014, report value code “FD” along with condition code 49 or 50.
- For services furnished prior to January 1, 2014, report the modifier “FB” on the same line as the procedure code (not the cochlear device code).
The Centers for Medicare & Medicaid Services (CMS) have a list of resources where you can find more about this topic. Go to https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/CochlearDevices-Resources.pdf.